Using behavioral insights in early childhood interventions

Using behavioral insights in early childhoodinterventions: The effects of Crianza Positiva text andvoice messaging program on parental investment and

competences

Ana Balsa Juanita Bloomfield Alejandro Cid

July 30, 2019

Balsa - Bloomfield - Cid Crianza Positiva text and voice messages July 30, 2019 1 / 24

Introduction

The Importance of a Safe and Nurturing Environment

A safe and nurturingenvironment is key for childdevelopment (Almond andCurrie, 2011; Cunha et al.,2006)

The production of cognitive andnon-cognitive skills of children ishighly dependent on parentalinvestment (Cunha et al., 2006)


Introduction

Socioeconomic gaps in parental investments

Families of lower SES:

spend less time with their children (Guryan et al. 2008)show them less expressions of affection at early ages (Bradley et al2001)are more likely to exert physical punishment on childrenare less likely to cognitively stimulate their childrenspeak less and read less to their children (Hart and Risley 1995):30mm fewer words by age 4


Introduction

Socioeconomic gaps in child development


Introduction

Can early environments be enhanced?

Early environments can be substantially enhanced by programs thatexpand and increase the quality of pre-school care, and byinterventions that foster parental competences (Berlinski and Schady,2015)

Parenting programs are yet scarce, targeted to specific populations,and in many cases short-lived and too costly to apply

The challenge is to design cost-effective parenting interventions thatcan be scaled up to broad fractions of the population and are able tosustain parental behaviors over time


Introduction

This paper

Evaluates a messaging parenting intervention aimed at reinforcing andsustaining positive parenting competences over time

Intervention key features:

Early childhood development scienceICT (audio and text messages)Behavioral economics tools

The messaging program is one of the components of ”CrianzaPositiva”, a multilevel intervention for parents of children aged 0-2

Messages are sent after families complete a parenting workshop of 8weekly sessions


Introduction

This paper







Introduction

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Introduction

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Introduction

Overview of findings

We find that the messaging program increases the frequency ofparental involvement with the child and the quality of that investment

The program had stronger effects over parents more constrainedinitially by a negative identity and over parents that suffered from anegative shock


Background

Behavioral economics and parenting

To a large extent, parental interventions have been designed assumingthat individuals act rationally (Gennetian et al., 2017).

Behavioral biases that interfere in the parent child-relationship:

Present bias and time inconsistencyComplexity of parental role, inattention and decision fatigueNegative identityStatus quo

By focusing on ways to overcome behavioral biases, behavioraleconomics offers some promising tools, generally of low cost, toenhance parental behaviors


Crianza Positiva Text and Audio Messaging Component

The Crianza Positiva Program

Evidence-based intervention aimed atimproving parenting practices andreinforcing children development

Designed to be implemented atChildren and Family Care Centers(CAIF) of Uruguay

Multilevel intervention with varyingtreatment intensities:

Level 1: 8-session workshop (Gomezand Munoz, 2014; Families First)Level 2: 24-weeks text messagesLevel 3: 4 counseling home visits



Crianza Positiva’s text and audio messaging component

72 messages sent to families three times a week over a period of 24weeks

Messages are sent at the same day and time to all family members(text+audio)

Structure organized around 12 biweekly modules:

M1: Reminder of a parental competence and its benefits /Reinforcement of positive identityM2: Suggestion of a specific activity to be undertaken with the childM3: Reinforcement of positive identity and invitation to reflect onperformance / Reinforcement of the importance of a parentalcompetence

SMS are personalized

Additional components: Commitments, Radio Butia, Facebook



Type of messages and examples by behavioral barrier

Behavioral bias Type of message to address this barrier Example

Present bias and time in-consistency

Messages that underscore the benefits ofparenting practices

Reminders about the importance ofparenting practices

Children’s brains are like sponges, they ab-sorb everything: the sounds, the pitches ofvoices, the language they listen to. Themore words your child listens to at this stage,the more [she] will develop [her] language. Itis therefore very important that you speakto [child’s name], this will impact heavily on[her] ability to learn.

Complexity of parentalrole, inattention, decisionfatigue

Messages that decompose complex parentaltasks into simple ones

Messages that relieve stress throughbreathing and relaxation techniques

Talk to [child’s name] while you are wash-ing [him] or changing [his] diapers. Look[him] in the eye when you speak to [him].When [child’s name] tries to respond, don’tinterrupt [him] and do not get distracted.[Child’s name] needs to know you are listen-ing.

Negative identityMessages that strengthen parentalself-efficacy and empowerment

Messages that show that feeling stressed outor underconfident is normal, and thatparents do overcome it

There is no one that wants as much for[child’s name] as you do. Think about oneor two moments in the past days in whichyou felt you really contributed towards [her]wellbeing. Trust yourself and continue seek-ing more of these moments during the week.

Status quo biasMessages suggesting concrete and simpleactivities

Messages reminding benefits of parentalinvolvement

The more you speak to [child’s name], thebetter will [his] language develop and themore [he] will learn. Today and in the follow-ing days, remember and repeat this thought:I take advantage of all the moments with[child’s name] to speak to [him].


Impact evaluation: Methodology

Theory of change



Experimental design

RCT after workshop completion

Sample and randomization:

Survey to collect mobile numbers

Intervention was delivered to all the contact numbers we had for eachfamily (SMS through web platform and audios through WhatsApp)

Control families received one SMS that thanked them forparticipating in the Crianza Positiva workshop



Experimental design








Experimental design








Outcomes

Sociodemographic characteris-tics

Sociodemographic questionnaire

Parental investment quantityFrequency of parental involvement in: physical games, didactic activities, social activitiesand caring activities with the child (Cabrera et al., 2004)Stimulating material resources index

Parental investment qualityPositive Parenting Scale (E2P) by Gomez and Munoz (2015)Father’s involvement subscale of the Etxadi-Gangoiti Scale of Arranz et al. (2012)Disciplinary methods used by parents (UNICEF MICS6)

Parental beliefsParenting Stress Index (Short Form) (PSI/SF)Parental Sense of Competence Scale (PSOC)Center for Epidemiologic Studies Depression Scale

Parental informationParental knowledge about positive parenting

Parental preferencesMonetary Choice Questionnaire (MCQ)



Attrition

Out of the 237 families randomized to receive messages, 72%responded to the follow-up questionnaire

The response rate for the 292 families randomized to the control armwas 78%

Probability of being surveyed

Difference in response rate between ITT=1 and ITT=0 -0.056(0.038)

Response rate control arm 0.777***(0.024)

N 529



Descriptive statistics and balance

Treatment Control BalanceN Mean Std. Dev N Mean Std. Dev. N Diff. Diff. s.e.

(1) (2) (3) (4) (5) (6) (7) (8) (9)

Mother’s age 168 30.292 6.626 225 28.311 6.552 393 1.981*** (0.672)Female child 170 0.482 0.501 227 0.498 0.501 397 -0.015 (0.051)Child’s age (in months) 167 23.343 7.014 226 24.419 6.115 393 -1.076 (0.678)Premature child 170 0.065 0.247 225 0.089 0.285 395 -0.024 (0.027)Intact family 167 0.719 0.451 224 0.777 0.417 391 -0.058 (0.045)Child still being breastfed 170 0.253 0.436 226 0.248 0.433 396 0.005 (0.044)# of other children in hhld 159 1.138 1.285 216 0.903 1.151 375 0.236* (0.129)Other adults in household 158 0.158 0.366 215 0.228 0.420 373 -0.070* (0.041)Housing material problems 158 0.291 0.456 218 0.303 0.461 376 -0.012 (0.048)No running water 168 0.018 0.133 226 0.022 0.147 394 -0.004 (0.014)No sanitation 168 0.024 0.153 226 0.031 0.174 394 -0.007 (0.017)No basic comfort goods 159 0.226 0.420 223 0.202 0.402 382 0.025 (0.043)Asset index 150 0.241 0.140 222 0.256 0.139 372 -0.015 (0.015)Beneficiary of cash transfers 170 0.700 0.460 227 0.634 0.483 397 0.066 (0.048)Mother responds qx 170 0.935 0.247 227 0.916 0.278 397 0.019 (0.026)Only child 163 0.337 0.474 220 0.414 0.494 383 -0.076 (0.050)Mother completed middle school 167 0.317 0.467 226 0.332 0.472 393 -0.014 (0.048)Mother completed high school 167 0.281 0.451 226 0.305 0.462 393 -0.024 (0.046)Mother works full time 165 0.388 0.489 217 0.401 0.491 382 -0.013 (0.051)Mother works part time 165 0.194 0.397 217 0.194 0.396 382 0.000 (0.041)Father works full time 151 0.808 0.395 215 0.767 0.423 366 0.041 (0.043)Family had negative shock 12m 165 0.642 0.481 224 0.576 0.495 389 0.067 (0.050)Number of negative shocks 165 1.394 1.480 224 1.192 1.415 389 0.202 (0.149)


Impact evaluation: Results

Results: Parental investment (time and material resources)

ITT effect (in SD) Std. error p-value p-value (after clustering) MHT p-value(1) (2) (3) (4) (5)

Parental investmentParental time investment index 0.337 (0.110) 0.002*** 0.002*** 0.012**

Physical games 0.279 (0.119) 0.020** 0.036** 0.067*Didactic Activites 0.302 (0.113) 0.008*** 0.018** 0.061*Social Activities 0.283 (0.122) 0.019** 0.020** 0.049**

Stimulating material resourcesToy diversity -0.203 (0.117) 0.091* 0.227 0.179More than 5 children book 0.003 (0.108) 0.978 0.985 0.976



Results: Parental investment (quality)


Positive Parenting CompetencesPositive Parenting Scale 0.248 (0.127) 0.051** 0.068* 0.051**

E2P: Attachment 0.111 (0.116) 0.337 0.381 0.341E2P: Routines 0.125 (0.106) 0.235 0.322 0.395E2P: Social support 0.233 (0.110) 0.036** 0.051* 0.099*E2P: Parental Reflection 0.268 (0.113) 0.018** 0.053* 0.064*

Father’s involvement -0.065 (0.111) 0.569 0.574 0.569Violent disciplinary approach -0.023 (0.109) 0.838 0.870 0.838



Mechanisms



Mechanisms 1: Effects on information, beliefs andpreferences


Parental Stress (decision complexity channel)Parental Stress Index (PSI) 0.092 (0.138) 0.508 0.692 0.508

PSI: Parental discomfort 0.179 (0.115) 0.12 0.408 0.292PSI: Dysfunctional Interaction -0.059 (0.124) 0.631 0.702 0.626PSI: Difficult child 0.127 (0.128) 0.322 0.433 0.520

Parental Sense of Competence (self-efficacy channel)Parental Sense of Competence Scale (PSOC) -0.044 (0.119) 0.714 0.751 0.714

PSOC: effectiveness 0.218 (0.112) 0.052* 0.203 0.105PSOC: controllability -0.161 (0.114) 0.155 0.428 0.147

Parental knowledge (information channel)Parental knowledge Scale -0.022 (0.023) 0.337 0.529 0.337Time preferences (time preferences channel)Discount rate 0.010 (0.010) 0.304 0.523 0.304



Mechanisms 2: Heterogeneity by barriers

Families with higher number of external shocks are more able toestablish routines, they need to rely less on the use of violentdiscipline and their sense of parental competence increases more.

Families with lower self-efficacy at baseline have a higherimprovement in reflection capacity, ability to organize routines, andmaterial investments.



Spillovers

Coeff. and s.e. Mht adjusted p-value Power

Parental time investment 0.099 0.700(0.453)

Physical games 0.100 0.804(0.126)

Didactic Activites -0.008 0.542(0.189)

Social Activities 0.162 0.656(0.153)

Father’s involvement -0.037 0.375(0.058)

Toy diversity -0.032) 0.228(0.025)

More than 5 children books -0.048 0.781(0.066)

Positive Parenting Scale (E2P) -0.037 0.694(0.078)

E2P: Attachment 0.062 0.412(0.09)

E2P: Routines 0.220 0.722(0.166)

E2P: Social support -0.260 0.703(0.18)

E2P: Parental Reflection 0.013 0.781(0.121)

Violent discipline 0.170** 0.049 0.159(0.084)

Parental Stress Index (PSI) 6.062 0.308(3.964)

PSI: Parental discomfort 3.805** 0.082 0.350(1.637)

PSI: Dysfunctional Interaction -0.283 0.320(1.162)

PSI: Difficult child 2.000 0.400(1.405)

Parental Sense of Competence Scale (PSOC) -0.083 0.745(0.097)

PSOC: effectiveness 0.104 0.458(0.153)

PSOC: controllability -0.209 0.272(0.198)

CES Depression Scale (# symptoms) -0.980 0.050(1.508)

CESD: At risk of depression -0.025 0.059(0.057)

Parenting knowledge -0.971*** 0.013 0.186(0.364)

Time discount rate 0.020 0.460(0.017)


Discussion and Conclusion

The program had a positive effect (of around 0.25 SD) on:

Parental investment quantity: frequency of involvement in physicalgames, didactic and social activitiesParental investment quality: outreach for social support and capacityto reflect on parenting

The program had stronger effects over parents more constrainedinitially by a negative identity and over parents that suffered from anegative shock

The program was well-received by families 95% said messages hadbeen very useful (61%) or somehow useful (34%)


Discussion and Conclusion

External validity:

the program was designed for any socioeconomic setting and wouldneed little adaptation to be delivered in other contextsthe intervention was embedded directly in a governmental-providedprogram which makes the implementation and results closer to areal-life intervention

Back-of-the-envelope cost of implementation: 10 USD per family.Very cost effective!

Extensions:

Understanding mechanismsMessages to families that have not participated in workshopMessages for families with older childrenOther contexts


Documents

Using behavioral insights in early childhood interventions